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. 2017 Jul;92(7):668-673.
doi: 10.1002/ajh.24745. Epub 2017 May 26.

Clinical presentation and outcomes of patients with type 1 monoclonal cryoglobulinemia

Surbhi Sidana  1 , S Vincent Rajkumar  1 , Angela Dispenzieri  1 , Martha Q Lacy  1 , Morie A Gertz  1 , Francis K Buadi  1 , Suzanne R Hayman  1 , David Dingli  1 , Prashant Kapoor  1 , Wilson I Gonsalves  1 , Ronald S Go  1 , Yi Lisa Hwa  1 , Nelson Leung  1   2 , Amie L Fonder  1 , Miriam A Hobbs  1 , Steven R Zeldenrust  1 , Stephen J Russell  1 , John A Lust  1 , Robert A Kyle  1 , Shaji K Kumar  1
Affiliations

Clinical presentation and outcomes of patients with type 1 monoclonal cryoglobulinemia

Surbhi Sidana et al. Am J Hematol. 2017 Jul.

Abstract

We describe a series of 102 patients diagnosed from January 1, 1990 to December 31, 2015 with Type 1 monoclonal cryoglobulinemia (MoC). Symptoms were seen in 89 (87%) patients, including: cutaneous symptoms in 64 (63%) patients, with purpura (n = 43, 42%) and ulcers/gangrene (n = 35, 34%) being most common; neurological findings in 33 (32%) patients, most frequently sensory neuropathy (n = 24, 24%); vasomotor symptoms, mainly Raynaud's phenomenon in 25 (25%); arthralgias in 24 (24%); and renal manifestations, primarily glomerulonephritis in 14 (14%) patients. An underlying lymphoproliferative disorder was identified in 94 (92%) subjects; MGUS-39, myeloma-20, lymphoplasmacytic lymphoma-21 and others-14. Treatment was initiated in 73 (72%) patients, primarily for cryoglobulinemia-related symptoms in 57. Treatment regimens consisted of: steroids ± alkylating agents in 29 (40%), novel myeloma therapies in 16 (22%), rituximab with alkylating agents in 12 (16%) and rituximab ± steroids in 11 (15%) patients; 22 patients received plasmapheresis. Six patients underwent autologous stem cell transplant. Cryocrit at treatment initiation, change in cryocrit and time to nadir cryocrit were predictive of symptom improvement. Treatment directed toward the underlying clonal disorder resulted in improvement (n = 47) or stabilization (n = 16) of symptoms in the majority of patients and disappearance of cryoglobulin in over one-half.

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Conflict of interest statement

CONFLICTS OF INTEREST

None

Figures

FIGURE 1
FIGURE 1
Kaplan-Meier survival plot in patients with Type 1 monoclonal cryoglobulinemia (a) survival in all patients (b) survival based on presence of neurological symptoms at presentation and (c) survival based on underlying hematological disorder: monoclonal gammopathy of undetermined significance (MGUS) vs. hematologic malignancy
See this image and copyright information in PMC

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